Restless legs syndrome is a seemingly unique condition and the cause is often difficult to pinpoint.

Few things are more frustrating than lying in bed at night, exhausted, but not being able to fall asleep because of an uncontrollable urge to move your legs. It seems so strange, doesn’t it? This phenomenon, known as restless legs syndrome (RLS), affects between 4% and 29% of adults in Western populations, and is a major contributor to sleep loss.

Pinpointing the cause of RLS has been an active research topic for years, but the condition is still not fully understood. The symptoms have been convincingly linked to impaired dopamine function in the brain, but the cause of this dysfunction is still being explored. Here are my top causes:

1. Systemic Inflammation & Immune Dysregulation (Subluxation)

One review paper published in 2012 investigated health conditions that were reported to cause or exacerbate RLS symptoms, and found that 95% of the health conditions that are associated with RLS have an inflammation or immune component. As further evidence, an elevated blood level of C-reactive protein (a marker of systemic inflammation) has been associated with increased RLS severity.

Researchers have proposed three potential mechanisms to explain the association between RLS and inflammatory or autoimmune states: direct autoimmune attack on the nervous system; genetic factors that could predispose an individual to RLS and be triggered by inflammation or autoimmunity; and vitamin D deficiency caused by inflammation, which I’ll talk more about below.

What to do: If your RLS is a symptom of underlying systemic inflammation or immune dysregulation, the goal should be to find and treat the root cause & reduce the stressors to the central nerve system and spine. Often we see the issue target to L5/S1 regions.

2. Small Intestinal Bacterial Overgrowth (SIBO) and IBS

A recent study found that 69% of RLS patients also had SIBO, compared with only 28% of control subjects. They also found that 28% of RLS patients had IBS, compared to only 4% of controls. And according to the 2012 review I mentioned above 32% of the health conditions associated with RLS are also associated with SIBO. As I’ve mentioned many times in the past neurological interference & gut infections are often the culprit—even if you don’t have noticeable symptoms—its worth getting your gut tested.

What to do: If you have RLS and suspect you may have SIBO or a gut issue its best to get tested to find our what is going on in there. Generally speaking, the intestines need to be flushed or cleansed then re-inoculated with healthy living strains of bacteria. Your typical probiotic won’t be able to do that. Overall the best approach is to follow a ketosis diet with bone broth until symptoms subside (and your SIBO tests are normal), and then gradually re-introduce fermented foods and probiotics.

3. Vitamin D Deficiency

One of the most-researched theories about the cause of restless legs syndrome is impaired dopamine signaling, which has led to the conventional treatment of RLS by dopamine agonists (i.e. chemicals that can bind to and activate dopamine receptors). Unfortunately, these treatments can become less effective over time, and can even result in a worsening of symptoms.

This is where vitamin D comes into play. The role of vitamin D in dopamine signaling is only beginning to be investigated, but some evidence indicates that vitamin D could play an important role by increasing levels of dopamine and its metabolites in the brain, as well as protecting dopamine-associated neurons from toxins.

RLS has been associated with vitamin D deficiency in several studies, and disease severity has been inversely correlated with vitamin D levels. One study has also found that vitamin D supplementation improved the severity of RLS symptoms.

What to do: If you have RLS, one of the easiest first steps you can take is to get your vitamin D levels tested. A good range to shoot for is typically between 40-60 ng/mL. If you have an autoimmune disease or another chronic health condition, optimal levels are between 60-80 ng/mL. One way to supplement vitamin D is through taking it directly. And of course, you should get regular sun exposure.

We’re still learning more and more about this syndrome, and hopefully we’ll come to some truly concrete answers soon enough. But as is so often the case, watching your nutrition and lifestyle goes a really long way in taking care of these sorts of issues.

Dr. Aaron Ernst completed his undergraduate education in pre-medicine/biology at Messiah University in Grantham, PA. As a first generation holistic practitioner, he began his career with a Doctorate in Chiropractic from Logan College of Chiropractic in Chesterfield, MO. While in Missouri, Dr. Aaron began helping patients rebuild their health in a Maximized Living Health center, which was the largest wellness clinic in Missouri. His experience has led him to spend countless hours studying and researching to create procedures and protocols to rebuild health naturally. Dr. Aaron has traveled all over North America, Europe and Africa teaching the principles of Maximized Living and educating all generations on gaining victory over disease naturally.